Sunday, August 02, 2015

This Sort Of Report Just Makes One Despair. What On Earth Is Wrong With Management Here?

This appeared a few days ago.

Troubled IT system for kids hospital

Angela Pownall
July 31, 2015, 10:36 am
A computer system that is causing problems for staff and patients at Fiona Stanley Hospital will still be rolled out at the new Perth Children’s Hospital.
Health chiefs are ploughing ahead with the digital medical record at the $1.2 billion hospital despite an independent review revealing many problems with the BOSSNet system at FSH.
FSH is the first WA hospital to roll out a digital medical record, replacing the traditional paper-based records system.
A long-awaited review, published last week by a team led by Australian Commission on Safety and Quality in Health Care clinical director Robert Herkes, found it was taking more than 15 minutes for staff to open all the applications within the system to admit and manage patients.
It also said clinicians reported being unable to put an alert on the system warning of a potentially serious issue with a patient, such as a reaction to a type of drug or the need for a patient to be seen urgently.
“This was seen as a safety and quality issue,” the report said.
A WA Health spokesman said the BOSSNet scanned medical record application would be implemented at PCH as planned, but with “system upgrades”. “The PCH project is now waiting for system upgrades which will have improved functionality to support use of the program at multiple hospital sites,” he said.
More here:
Looking around to understand a bit more I found this link.

BOSSnet live at the state of the art Fiona Stanley Hospital in ...
In October, Fiona Stanley went live with the BOSSnet digital medical record, scanning and electronic forms, which will enable clinicians to quickly and easily ...
It did not work but another route got me this:

BOSSnet live at the state of the art Fiona Stanley Hospital in WA

The state-of-the-art Fiona Stanley Hospital is the first hospital in Western Australia to store patients’ medical records online, allowing access to patient information throughout the hospital, and potentially to clinicians anywhere in the state.
In October, Fiona Stanley went live with the BOSSnet digital medical record, scanning and electronic forms, which will enable clinicians to quickly and easily access a single electronic view of a patient’s record and share that information with practitioners right along the continuum of care.
The BOSSnet system offers significant benefits over the traditional paper-based method of managing patient information, including reduced clinical and administrative risk from delayed or lost paper records, reduced costs to the health system related to paper record storage and incorrect data entry and better and timely access to accurate patient information at the point of healthcare delivery.
Core Medical Solutions Managing Director Dr Rohan Ward says this is an exciting time for healthcare in Western Australia.
“WA clinicians will now have better and more timely access to accurate information about their patients. That’s good news for practitioners and patients right along the continuum of care”.
“For Core Medical Solutions, this represents the next stage of our significant growth across Australia, We’re now servicing more than 50 hospital sites across the country, and looking forward to working with hospitals right across the state of Western Australia”, Dr Ward said.
BOSSnet is also being implemented at the Perth Children’s Hospital, which is due to open its doors in 2015, marking the beginning of the next stage of the BOSSnet rollout in the state.
See here:
The review (mentioned above) provides some grim coverage of the IT at the Fiona Stanley Hospital is found here:

Here is an extract 

State Information Communication Technology

FSH is the first WA public hospital to implement a Digital Medical Record  (DMR). The DMR (BOSSnet) is a digitised version of the traditional integrated  paper-based medical record.
The DMR initially comprises of:
1. Direct data entry eForms completed by clinicians that can be viewed in the DMR in real time. Currently these include an admission form, integrated progress notes, team conference/ multidisciplinary team notes, nursing risk screening tools and assessment forms.
2. Electronic documents received from other clinical systems used across FSH such as Cardiobase, NaCS, TEDS, CGMS, STORK, eCONSULT, PROCREP and eReferrals viewable in real time.
3. Critical alerts from the patient administration systems (web PAS and TOPAS) and anaesthetic alerts.
4. Allergies sourced from NaCS and the FSH eDiet application.
A major change for many clinicians working at FSH relates to the introduction of the new bedside information technology. As yet, the multiple applications that form the DMR are not fully integrated so clinicians cannot easily move from one application to the next.
Problems were also reported with the DMR’s inability to put an alert on the  system (warning about an impending potential issue e.g. a reaction to a type of drug or the need for the patient to be seen urgently); this was seen as a safety and quality issue.
The introduction of the DMR has allowed the start of efficiencies in the care of patients and communication between team members. Each patient’s clinical notes are available to multiple staff members at the same time. This allows for instance, the surgical team to access the patients’ notes on a ward round at the same time as the social worker is accessing the notes to facilitate the patient’s transfer to a rehabilitation facility.
Currently, to open all applications within the DMR to admit and manage a patient takes approximately 15 minutes due to the integration issue. Staff at FSH have expressed concerns that as the new children’s hospital progresses to opening, Information and Communication Technology (ICT) enhancements and fixes will be further delayed as the same ICT staff involved in developing the programs become overextended.
Technology changes are also an issue within the outpatients department where it can also take in excess of 15 minutes to open all the software to manage the patient’s notes.
Furthermore, clinicians with less computer experience find it difficult to type with sufficient speed and/or accuracy which further reduces patient throughput. It was noted that there was a good dictation service (transcription) in place which was appreciated by many clinicians.
---- End Extract
So it seems a brand new hospital is just about to have a system inflicted on it that it not working at another large hospital in the same state that was reviewed only a month or so ago and found to be deeply unsatisfactory - even six months + after implementation!
Frankly if I worked at the old hospital, and was about to move to a new hospital with this system, I would be in open revolt to cause a re-think.
I won’t even start get involved in the use of the scanned approach to EMRs rather than more modern approaches.
I reckon those who wrote the report on FSH were remarkably restrained - and in fact should have been much clearer about how unacceptable what is going on at the time of review is!
Wanders off shaking head in despair.


Terry Hannan said...

David, you despair is palpable. Soemwhat of the "blind leading the blind" or trying to make "the dumb to speak, the deaf to hear and the blind to see".
I am not sure if this perpsective is also valid when one TRIES to grasp what these projects are attempting to do in the light of our supposed national eHealth policies e.g PCEHR.
These projects are NOT privately funded. They use taxpayers money and as you correctly point out these expenditures are not pocket money but BILLIONS.
As I have stated previously in paraphrasing Brent James on Quality. What are the costs and outcomes to repair these "Preventable" poor outcomes.
Also know as the NFI Syndromes.

Bernard Robertson-Dunn said...

There's a report in the Medical Journal of Australia about GPs and hospital doctors speaking a different language.

Here's an article on the report.

It's also in the printed SMH, but I can't find a web version.

In a worrying finding that could explain some catastrophic errors for Australian patients, a survey of 240 GPs found they did not understand much of the shorthand used by hospital doctors in electronic handover notes.

After compiling a list of 321 abbreviations used in 200 discharge letters produced by a major Sydney hospital, researchers surveyed the GPs to see how many of those abbreviations they understood.

They found that six abbreviations were misinterpreted by more than a quarter of the GPs surveyed.

Does the PCEHR recognise this as an issue? Do any eHealth record systems?
Does anyone have a proposed solution?